Postural dysautonomia in response to head-up tilt in a military pilot aspirant: Aeromedical considerations

Intolerance to orthostasis encompasses a group of responses on assumption of upright posture. One such response is postural dysautonomia. One of the types of postural dysautonomia is postural orthostatic tachycardia syndrome, which is characterised by an increase in heart rate of more than 30 bpm without hypotension along with other features of dysautonomia on attaining an erect posture, either actively or passively. This paper brings out a case of postural dysautonomia in a pilot aspirant in response to Head-up tilt (HUT) test. A 23-year-old female military pilot aspirant reported for evaluation of Syncope and Air Sickness. She gave a history of solitary episode of loss of consciousness on ground while preparing for an early morning sortie. She was diagnosed with a case of neurocardiogenic syncope and was put back to flying training. Subsequently, after about 2 months, she developed features of air sickness while flying and also could not tolerate preliminary motion sickness desensitisation at her unit. A thorough medical evaluation failed to reveal any neurocardiological abnormality. Before commencing the air sickness desensitisation protocol at the Institute of Aerospace Medicine, she was subjected to HUT during which she developed signs and symptoms suggestive of postural dysautonomia. A test retest assessment with repeat HUT and passive standing test revealed similar responses.

Rapid ARC Radiotherapy in a Patient with Bilateral Breast Carcinoma - 10 Year Follow UP

Introduction: A patient with synchronous bilateral breastcancer was treated with Rapid arc (Volumetric Modulated Arctherapy - VMAT) radiotherapy following breast conservationsurgery. She is alive and without radiotherapy complicationsin the 10 year follow up period.Case report: A 51 year old lady presented with synchronousbilateral breast cancer. She underwent wide excision of bothbreast lumps with bilateral axillary lymph node sampling(Invasive Ductal Carcinoma, pT1N1 in left breast and pT2N0in right breast). She was treated with adjuvant chemotherapyand post-operative radiotherapy to both breasts with rapidarc (VMAT) technique in August 2009. The radiotherapyplanning was compared among Three Dimensional ConformalRadiotherapy, Intensity Modulated Radiotherapy and Rapidarc techniques. Details of dose homogeneity and sparing ofOrgans at risk are discussed. She tolerated the treatment wellwithout major toxicity. She has been on regular follow up tillher last visit in June 2019. She was also treated for surgeryfollowed by radiotherapy for Carcinoma of cervix 12 yearsago.Conclusion: This case is presented for the novel radiotherapytechnique in treating bilateral breast cancer resulting in goodquality of life and long term survival.

Double orifice mitral valve: report of 4 cases.

Double Orifice Mitral Valve (DOMV) is a rare congenital abnormality. Reports of 4 patients with DOMV are presented. As associated anomalies, one had ostium primum atrial septal defect (ASD). Second one had Ebstein's anomaly. Third one had grade IV tricuspid regurgitation, thickened tricuspid valve and right atrial mass. Fourth one had sinus venosus ASD. Echocardiography is the gold standard investigation. Surgical treatment depends upon the mitral valve function and associated anomalies.

Cauliflower growths in trophic ulcers of leprosy--a 10 year study.

A 10 year study of cauliflower growths in trophic ulcers of leprosy patients was done. Seventy five cases were seen, out of which seventy two were in foot and three in hand. Eventhough appearance was like that of malignancy, malignant change was seen only in four cases and in other seventy one cases it was pseudoepitheliomatous hyperplasia. Various surgical procedures were done. Wide excision appears to be the procedure of choice where feasible as per our studies.